Why Strokes in Young People Are on the Rise

Why Strokes in Young People Are on the Rise

Are there more risk factors or is it better stroke diagnosis?

Age is a major risk factor for having a stroke—in fact, the risk of stroke doubles for each decade after age 55. But a study published in the Journal of the American Heart Association in May 2016 found, while hospitalizations for ischemic strokes overall have dropped 18.4 percent between 2000 and 2010, hospitalizations for ischemic strokes in people between the ages of 25 and 44 have risen by 44 percent.

Another study, this one published in April 2017 in JAMA Neurology, backs this up. Ischemic stroke hospitalizations between 2003 and 2012 rose by 41.5 percent for men between the ages of 35 and 44, and 30 percent for women of the same age.

Is there an epidemic of ischemic stroke striking the young and middle-aged? Not exactly, says Noor Sachdev, MD, a neurologist with Good Samaritan Hospital in San Jose, California. “I don’t think anything has changed dramatically,” he says. So why the big jump in strokes in younger people? Read on for Dr. Sachdev’s take and learn what you can do to reduce your risk of having a stroke.

Education and diagnosis
Sachdev believes the 44 percent rise is due to better diagnosis, both on the patient side and the doctor side. “Younger people know more about the symptoms of stroke so they are coming into the hospital sooner and seeking treatment,” he says. “Our capabilities of diagnostic testing are better. I am not sure it’s true that suddenly people are having more strokes in that age group, but we’re seeing that people are more educated about it, whereas before these technologies and advances in treatment, the diagnosis was more difficult to make.”

Groups like the American Heart Association and the American Stroke Association have worked hard to educate people about strokes, says Sachdev. Younger people may also have parents who have experienced stroke, so they could be familiar with stroke symptoms and effects. “Plus, they have the Internet. If they have a symptom they can look it up,” he says.

Call 911 as soon as you realize you or someone else is having a stroke. First responders are now trained in identifying stroke patients and taking them to stroke centers where they can receive treatment quickly. CT scans are the first step in diagnosing stroke. A CT scan can determine whether there is bleeding in the brain (hemorrhagic stroke), or determine if it’s an ischemic stroke (clot based stroke).

The treatment changes depending on the results of the CT scan.  Further testing such as MRIs, CT angiograms and perfusion studies, ultrasounds or cerebral angiograms also help to diagnose stroke and its cause. “The technology is getting better. There is now software that can analyze cerebral blood flow, which can tell us if there’s a clot, what area of the brain is lacking blood flow and if there’s tissue that can be salvaged.”

Causes of and recovery from strokes in young people
The seeming increase in strokes in young people could be due to diagnostic advances and education, but the root causes of stroke are likely to be different in younger patients. “The differential for stroke in young people is really broad,” says Sachdev. While atherosclerosis is the most common cause of stroke overall, other artery problems like vasculitis, heart abnormalities, dissection (vessel tear) and blood clots are collectively the most common reason for strokes in younger patients.

Recovery often differs in younger patients too, and that’s the good news, says Sachdev. “Younger patients, just by the nature of the brain itself, will heal faster no matter what you do,” he says. “You don’t get brain tissue back, but you have neuroplasticity, a constant rewiring and renetworking of the brain.” Younger people may also heal faster because they’re generally stronger, have fewer other diseases and can tolerate the sometimes-grueling physical therapy that doctors recommend better, says Sachdev.

Preventing a stroke
Whether you’re 25 or 75, there are many steps you can take to prevent a stroke. “We’ve gotten better in terms of medication, but lifestyle is key,” says Sachdev. “The number one risk factor is a previous stroke, followed closely by hypertension, diabetes, high cholesterol, smoking and obesity. Put those together and you’ve got a ticking time bomb. You’ve got to make a dramatic change. Just by meeting basic government recommendations on exercise, you can increase your life expectancy by seven years.”

The Centers for Disease Control and Prevention recommends people get at least 150 minutes per week of moderate exercise or 75 minutes per week of vigorous exercise.

According to a study published in July 2016 in The Lancet, there are 10 risk factors that are responsible for about 90 percent of all strokes worldwide—many of which can be reduced by making the right lifestyle changes. The authors wrote that high blood pressure is “the most important modifiable risk factor.” Other risk factors in the study include:

  • Smoking
  • Waist-to-hip ratio
  • Diet
  • Physical activity
  • Drinking alcohol
  • Diabetes

“Things happen in life that you can’t control, but you can control your health,” says Sachdev. “The culture of medicine is changing with the patient taking more responsibility for their health rather than just coming to the doctor to be fixed. There’s enough knowledge out there that shows how critical lifestyle modification is to overall health and well-being.”

This article was updated on April 18, 2017